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Klain, A.; Dinardo, G.; Indolfi, C.; Contieri, M.; Salvatori, A.; Vitale, S.; Decimo, F.; Ciprandi, G.; Miraglia Del Giudice, M. Oral Probiotics and Allergic Rhinitis. Encyclopedia. Available online: https://encyclopedia.pub/entry/42222 (accessed on 20 July 2025).
Klain A, Dinardo G, Indolfi C, Contieri M, Salvatori A, Vitale S, et al. Oral Probiotics and Allergic Rhinitis. Encyclopedia. Available at: https://encyclopedia.pub/entry/42222. Accessed July 20, 2025.
Klain, Angela, Giulio Dinardo, Cristiana Indolfi, Marcella Contieri, Alessandra Salvatori, Sossio Vitale, Fabio Decimo, Giorgio Ciprandi, Michele Miraglia Del Giudice. "Oral Probiotics and Allergic Rhinitis" Encyclopedia, https://encyclopedia.pub/entry/42222 (accessed July 20, 2025).
Klain, A., Dinardo, G., Indolfi, C., Contieri, M., Salvatori, A., Vitale, S., Decimo, F., Ciprandi, G., & Miraglia Del Giudice, M. (2023, March 15). Oral Probiotics and Allergic Rhinitis. In Encyclopedia. https://encyclopedia.pub/entry/42222
Klain, Angela, et al. "Oral Probiotics and Allergic Rhinitis." Encyclopedia. Web. 15 March, 2023.
Oral Probiotics and Allergic Rhinitis
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This entry is adapted from the peer-reviewed paper 10.3390/allergies3010006

Allergic rhinitis (AR) is a respiratory disease caused by an IgE-mediated inflammatory process mediated by one or more antigens (allergens) against which the subject is sensitized. The most common symptoms are rhinorrhea, sneezing, itching, nasal obstruction, and frequent conjunctivitis. However, drugs used to treat AR may accompany adverse side effects (e.g., dry mouth, drowsiness, dizziness related to anti-H1 drugs). The use of probiotics as an additional option is increasing globally. The consumption of probiotics is expected to modulate immune responses in AR patients, reduce the damage caused by inflammation, and restore a balanced gut microbiota. Gut microbiota is known to function as immunomodulator, barrier, and protective tool against infections. It is constituted of more than a trillion microorganisms reunited in a complex and dynamic ecosystem, regulating the immune system and systemic physiology.

allergic rhinitis probiotics gut

1. Gut–Lung Axis

The gut microbiota is connected with the respiratory tract: alterations in the quantitative composition, qualitative content (biodiversity) or the activity and function of gut microbiota, known as dysbiosis, can affect the immunity and microbiota of the lung and vice versa. This crosstalk is called the gut–lung axis. The lung is, in turn, connected with upper airways, according to the concept of ‘united airway disease’ [1]. The upper-lower airways link occurs due to anatomical, physiological, pathological, and immunological mechanisms, such as the common presence of ciliary epithelium, mucous glands, and the existence of the nose–pharyngeal–bronchial reflex [2]. This connection is essential to understand the link between the microbiota and bronchial and nasal hyperreactivity in healthy and diseased patients.
Probiotics are live microorganisms that, after oral administration, colonize the gastrointestinal tract with the goal of guaranteeing a health benefit to the host [3]. There are many probiotics, most of which can also be found naturally in the human body. They are classified into the following five species: the Lactobacillus group (e.g., L. reuteri RC-14), the Bifidobacterium group (e.g., B. bifidum), the Streptococcus group (e.g., S. fecalis), the Bacillus group (e.g., B. subtilis), and other organisms (e.g., non-pathogenic yeast Saccharomyces boulardii, Escherichia coli). They can help the respiratory, digestive, and immunological functions due to the ability to promote the maturation of the humoral responses, the IgA particularly, to improve the Th1 immune response and reduce Th2 cytokines, resulting in anti-inflammatory effects [4].
Oral probiotics can modulate the immune response of the respiratory system. They can contribute to treat, as add-on, and prevent respiratory diseases, such as asthma and allergic rhinitis (AR) by determining changes in gut microbiota and immune response [5]. Indeed, several studies indicated that probiotics could efficiently alleviate the symptoms of AR patients [6].
There have been promising developments in probiotics as adjuvant treatments for controlling nasal dysbiosis [7]. The use of probiotics was not only suggested to treat allergic diseases, but may be beneficial also for the immune response to viral respiratory infections, such as respiratory syncytial virus, rhinovirus [8], influenza virus [9][10], and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, Coronavirus Disease 19 (COVID-19) is an infectious disease that affects mainly the respiratory system but also the gastrointestinal tract (GIT) [11]. The involvement of the GIT causes mild to severe symptoms, such as diarrhea, lack of appetite, abdominal pain, and vomiting [12]. During the infection, there is a reduction in biodiversity and richness of the gut microbiota, immune dysregulation, and prolonged infection may occur due to delayed SARS-CoV-2 clearance [13]. Due to the involvement of both respiratory and gastrointestinal systems and the relevant modifications that occur in local microbiota, therapies able to modulate the gut–lung axis and promote the eubiosis, such as probiotics, could be an important additional therapeutic strategy to fight COVID-19 infection [13][14].
To date, no relevant adverse events were observed for probiotic use; thus, probiotic use appears safe.
All these data demonstrate the importance and effectiveness of administering probiotics (as single strain or mixture) to modulate the gut and respiratory microbiota, thus improving prognosis and reducing symptoms in patients with allergic diseases and respiratory viral infections, such as COVID-19 (Figure 1).
Allergies 03 00006 g001 550
Figure 1. The Gut–Airways Axis.

2. Probiotic Food

It is important to remember that food can also be an important source of probiotics. Dairy products, in particular yogurt, yogurt products, and milk, are excellent probiotic carriers [15]. Yogurt can be subdivided into two different classes: the standard culture yogurt, which is made with Lactobacillus bulgaricus and Streptococcus thermophilus, and bio- or probiotic yogurt, which is made by culturing additional microorganisms, generally Bifidobacteria and Lactobacillus acidophilus [16]. Many fermented food and beverages are another important source of probiotics, having several nutritional and therapeutic effects [17]. It is also possible to supplement many food products with probiotics, but their ability to deliver viable cells to the human gut may be different, because of the physical and chemical features of the food (e.g., pH, percentage of oxygen, presence of additives, titrable acidity), processing (e.g., fermentation conditions, cooling), storage (e.g., packaging materials), and microbiological parameters (e.g., strain probiotic chosen, inoculation) [18]. In the observational study conducted by Butler et al., the association between the intake of unpasteurised milk and dairy products for twelve weeks and the intestinal microbiota composition was evaluated. They enrolled twenty-four participants aged 18 to 65 years, with no chronic or current, mental or physical disease and collected their fecal samples at the beginning and end of the twelve weeks. They observed a significant increase in the presence of the genus Lactobacilli between the first and the twelfth weeks, thus demonstrating that dairy products can be a rich source of probiotic bacteria [19]. Ha-young Jeon et al. investigated the potential effects of the administration of a yogurt containing high-dose probiotics, such as Lactobacillus acidophilus and Streptococcus thermophilus, on viral respiratory infections such as influenza H1N1 and SARS-CoV-2 in an in vitro and in vivo experiment, using virus-infected animal models. They demonstrated that the administration of yogurt containing high-dose of probiotics could contribute to prevent and treat influenza H1N1 in a significant manner, reducing plaque formation in the virus-infected cells, and ameliorating the condition of influenza H1N1-infected mice. Unfortunately, the improvement effect for SARS-CoV-2 infection was less evident [20].
Commercial oral probiotic products are nowadays widely distributed, consumed and available, but there are still some concerns about their costs, efficacy, probiotic strain used, and treatment duration. It is important to remember that dietary intake has always played a major role in regulating intestinal microbiome composition and it can still represent a viable option to prevent or treat dysbiosis.

3. Probiotics and Allergic Rhinitis: Evidence and Challenges

In AR, drugs such as second-generation antihistamines or intranasal corticosteroids are prescribed for long-term control of symptoms [21]. Nevertheless, their long-term adverse effects could limit patients’ daily lives, causing drowsiness, gastrointestinal disorders, dry mouth, dizziness, headache, or infections. Moreover, these drugs’ effectiveness often depends on the time of the allergy’s onset. Therefore, the regular administration of probiotics seems to be a suitable therapeutic option because of its safety in long-term treatment regimens and because it also leads to clinical improvement in AR patients [22][23][24]. Overall, probiotic use appears safe, although a risk of infectious complications (e.g., bacteremia, endocarditis, sepsis) has been described in the literature [25][26][27]. Virulence appears to differ by species, in particular, the Lactobacillus (e.g., rhamnosus, acidophilus) and Bacillus species seem to be the most dangerous. Sepsis following probiotic usage was mostly reported in immune-deficient/malnourished patients, with important comorbidities (e.g., HIV, diabetes) [25]. Some individuals had extensive ulcerations of the mucosa of the GIT, congenital heart diseases, or had undergone antitumor chemotherapies or ionizing radiation [26]. Most patients were also treated with broad spectrum antibiotics and covered with probiotics to prevent/treat the diarrhea which often follows [27]. Therefore, since such complications were just reported sporadically, and because of their proven utility, probiotics’ use in AR seems reasonable.

4. The Role of Probiotics in the Prevention of Allergy during Pregnancy

The World Allergy Organization supports probiotic supplementation in pregnant women and infants at high risk of allergy [28]. In this regard, it is important to note that during pregnancy, there is an increase in the bacterial load and alterations in the maternal gut microbiota, such as the major representation of Actinobacteria and Proteobacteria and reduced the presence of Faecalibacterium and other short-chain fatty-acid producers [29][30]. These changes in maternal gut microbiota may have consequences in terms of immunity, health, and growth of the fetus [31]. It is known that maternal microbiota has a role in shaping the offspring’s immune system in terms of immune gene expression and the number of innate immunity cells [32]. Furthermore, many studies showed the role of microbial exposure during pregnancy in preventing allergic disease in the offspring [33]. Creating an appropriate intestinal microbiota in neonates is crucial for guaranteeing them protection from enteric pathogens and local and systemic inflammation. This process is influenced by the infant’s diet, maternal microbiome, and environment. Pregnancy and the period from birth to 24 months (B-24) are sensitive windows during which diet has a powerful influence on the life trajectory of health [34]. A recent analysis of four randomized, double-blind, placebo-controlled clinical trials found that administration of perinatal L. rhamnosus was associated with a decrease in allergic disease in infants with no safety concern [35]. In this regard, a meta-analysis performed by Zuccotti et al. suggested that the administration of probiotics during pregnancy prevented atopic dermatitis in children [36]. Accordingly, Bertelsen et al. showed that probiotic Lactobacilli and Bifidobacteria during pregnancy decreased the incidence of atopic dermatitis and rhinoconjunctivitis in children [37]. Another meta-analysis of seventeen randomized controlled trials performed by Du et al. demonstrated that supplementation with probiotics in pre- and postnatal periods successfully prevented asthma, but the effects depended on the type of probiotic mixture used [38]. It is important to note that probiotic supplementation may also have a protective role against preeclampsia, vaginal infections, gestational diabetes, later childhood disease, and maternal and infant weight gain [39]. These data provide compelling evidence that the maternal microbiome influences the infant microbiome, which subsequently affects childhood health, and that the administration of probiotics during pregnancy, lactation, and postnatal life could be a safe and effective strategy to modify both the maternal and neonatal microbiota, thus improving pregnancy and neonatal outcomes [40]. On the other hand, some studies reported discordant results on the benefit of the use of probiotics in pregnancy, possibly due to the use of different strains of probiotics, study period, other methods of administration and follow-ups. In this regard, a randomized study by Boyle et al. recruited 250 pregnant women carrying infants at high risk of allergy disease. They administered to 125 women a probiotic supplementation with Lactobacillus GG each morning for thirty-six weeks of gestation until delivery, and to the other 125 women, they administered a maltodextrin placebo. They found no evidence that prenatal treatment with LGG prevented eczema [41]. A study by Simpson et al. recruited 415 pregnant women. They were randomized in a double-blind study to receive probiotic milk or placebo from thirty-six weeks of gestation until three months postpartum. The probiotic milk contained Lactobacillus rhamnosos GG, L. acidophilus La-5, and Bifidobacterium animalis subsp. Lactis Bb-12. Afterwards, they evaluated their children through clinical examinations and family questionnaires. The results suggested that there was no significant reduction in the prevalence of asthma, atopic sensitization, and allergic rhinoconjunctivitis, but only reduction in atopic dermatitis [42].

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Subjects: Pediatrics
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Angela Klain
,
Giulio Dinardo
,
Cristiana Indolfi
,
Marcella Contieri
,
Alessandra Salvatori
,
Sossio Vitale
,
Fabio Decimo
,
Giorgio Ciprandi
,
Michele Miraglia del Giudice
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Update Date: 16 Mar 2023
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